Additional dosage information:

Usual Adult Dose for Bacterial Infection

Manufacturers' general recommendations:IV:
Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg IV per day, depending on the severity of the infection; 200 mg may be given in 1 or 2 infusions

Oral:
Initial dose: 200 mg orally on the first day, given in 2 or 4 divided doses
Maintenance dose: 100 mg orally per day, given once a day or in 2 divided doses
More severe infections: 100 mg orally every 12 hours

Usual Adult Dose for Amebiasis

Approved indication: As an adjunct to amebicides in acute intestinal amebiasis

Some experts recommend: 100 mg orally twice a day as an adjunct to amebicides

Usual Adult Dose for Anthrax Prophylaxis

Postexposure prophylaxis: 100 mg orally or IV every 12 hours for 60 days after initial exposure

Comments:
-The Working Group on Civilian Biodefense has recommended doxycycline as an alternative agent to ciprofloxacin for postexposure anthrax prophylaxis after an intentional Bacillus anthracis release.

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

Usual Adult Dose for Cutaneous Bacillus anthracis

(Not approved by FDA)

Working Group on Civilian Biodefense recommendations: 100 mg orally or IV every 12 hours for 60 days after initial exposure

Comments:
-IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present.
-Ciprofloxacin or doxycycline recommended for the treatment of cutaneous anthrax after an intentional B anthracis release.

Usual Adult Dose for Inhalation Bacillus anthracis

100 mg orally or IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics with activity against anthrax (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin).

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]), to reduce the incidence or progression of disease following exposure to aerosolized B anthracis

Working Group on Civilian Biodefense Recommendations for Treatment of Anthrax Used as a Biological Weapon:
Contained casualty setting: 100 mg IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics.
-May switch to oral therapy when clinically appropriate
-Ciprofloxacin and doxycycline are recommended for the treatment of pulmonary anthrax in a contained casualty setting.

Mass casualty setting: 100 mg orally every 12 hours for 60 days

Comments:
-Doxycycline is recommended as an alternative to ciprofloxacin for the treatment of pulmonary anthrax in a mass casualty setting.

Usual Adult Dose for Upper Respiratory Tract Infection

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to Streptococcus pneumoniae

Some experts recommend: 100 mg orally every 12 hours for 7 to 10 days

Usual Adult Dose for Bronchitis

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to Streptococcus pneumoniae

Usual Adult Dose for Brucellosis

Approved indication: For the treatment of brucellosis due to Brucella species (combined with streptomycin)

Some experts recommend: 100 mg orally twice a day for 6 weeks, in combination with gentamicin, streptomycin, or rifampin

Usual Adult Dose for Cervicitis

(Not approved by FDA)

CDC recommendations: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline is recommended as presumptive therapy; concomitant treatment for gonococcal infection should be considered if incidence is high in patient population.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of acute epididymo-orchitis due to C trachomatis or Neisseria gonorrhoeae

Usual Adult Dose for Gastroenteritis

(Not approved by FDA)

Some experts recommend:
-Due to Listeria monocytogenes or Yersinia enterocolitica: 100 mg orally twice a day
-Due to Tropheryma whippelii: 100 mg orally twice a day for 1 year after initial 10- to 14-day therapy with penicillin G, streptomycin, or ceftriaxone

Usual Adult Dose for Gonococcal Infection - Uncomplicated

100 mg orally twice a day for 7 days

Alternate single visit dose: 300 mg orally initially followed in 1 hour by a second 300 mg dose

Comments:
-Not recommended for anorectal infections in men.

Approved indication: For the treatment of uncomplicated gonorrhea due to N gonorrhoeae

CDC recommendations: 100 mg orally twice a day for 7 days

Comments:
-The recommended regimen for uncomplicated infections of the cervix, urethra, rectum, or pharynx includes ceftriaxone plus (azithromycin [preferred] or doxycycline).
-If ceftriaxone is not available for uncomplicated infections of the cervix, urethra, or rectum, an alternative regimen includes cefixime plus (azithromycin [preferred] or doxycycline) plus test-of-cure in 1 week.
-Due to high tetracycline resistance among surveillance isolates, azithromycin is preferred as the second agent.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Lyme Disease - Arthritis

Comments:
-Recommended for treatment of uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease

Usual Adult Dose for Lyme Disease - Carditis

(Not approved by FDA)

IDSA recommendations: 100 mg orally every 12 hours for 10 to 21 days

Comments:
-Recommended for patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of hospitalized patients; an oral regimen should be used for completion of therapy and for outpatients.

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

IDSA recommendations: 100 mg orally every 12 hours for 10 to 21 days

Comments:
-Recommended for treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent

Usual Adult Dose for Lyme Disease - Neurologic

(Not approved by FDA)

IDSA recommendations:
Lyme meningitis and other manifestations of early neurologic Lyme disease: 100 to 200 mg orally every 12 hours for 10 to 28 days

Usual Adult Dose for Lymphogranuloma Venereum

Approved indications: For the treatment of lymphogranuloma venereum due to C trachomatis

CDC recommendations: 100 mg orally twice a day for 21 days

Comments:
-Doxycycline is the preferred therapy.
-Patients should be clinically monitored until signs/symptoms have resolved.
-Prolonged therapy may be needed for HIV-infected patients; delay in symptom resolution may occur.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Malaria

(Not approved by FDA)

CDC recommendations:
Uncomplicated malaria due to chloroquine-resistant Plasmodium falciparum or P vivax: 100 mg orally twice a day for 7 days
Severe malaria: 100 mg orally or IV twice a day for 7 days

Comments:
-Doxycycline must be used with a fast-acting schizontocide (e.g., quinine); primaquine also required if treating P vivax or P ovale.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Malaria Prophylaxis

100 mg orally once a day

Comments:
-Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas.
-Doxycycline prophylaxis should not exceed 4 months.

Approved indication: For prophylaxis of malaria due to P falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Usual Adult Dose for Melioidosis

(Not approved by FDA)

Some experts recommend: Doxycycline 100 mg orally twice a day plus chloramphenicol 10 mg/kg orally (not available in the US) 4 times a day plus sulfamethoxazole-trimethoprim 5 mg/kg (trimethoprim component) orally twice a day
Duration of therapy: Doxycycline and sulfamethoxazole-trimethoprim for 20 weeks; chloramphenicol for the first 8 weeks

Comments:
-This oral regimen may be initiated after the patient has received parenteral treatment with ceftazidime, imipenem, or meropenem for at least 10 days.

Usual Adult Dose for Nongonococcal Urethritis

100 mg orally twice a day for 7 days

Comments:
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of nongonococcal urethritis due to C trachomatis or Ureaplasma urealyticum

Usual Adult Dose for Pelvic Inflammatory Disease

Comments:
-A recommended parenteral regimen is (cefotetan or cefoxitin) plus doxycycline; an alternative parenteral regimen is ampicillin-sulbactam plus doxycycline.
-Parenteral therapy can be stopped 24 hours after clinical improvement but oral doxycycline should continue to complete 14 days of therapy; when tuboovarian abscess is present, metronidazole or clindamycin can be used with doxycycline for continued therapy (provides more effective anaerobic coverage than doxycycline alone).
-Recommended regimens for outpatient, oral therapy include (ceftriaxone or cefoxitin/probenecid or other parenteral third-generation cephalosporin) plus oral doxycycline with or without metronidazole.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Periodontitis

20 mg orally twice a day for up to 9 months

Comments:
-Should be taken at least 1 hour prior to or 2 hours after meals.
-Safety and efficacy not established beyond 12 months and 9 months, respectively.

Approved indication: As an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in patients with periodontitis

Usual Adult Dose for Plague

Approved indication: For the treatment of plague due to Yersinia pestis

Some experts recommend: 100 mg orally or IV twice a day for 10 days

Working Group on Civilian Biodefense Recommendations for Treatment of Plague Used as a Biological Weapon:
Contained casualty setting: 100 mg IV twice a day or 200 mg IV once a day
Duration of therapy: 10 days (or until 2 days after fever subsides)

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting:
Treatment: 100 mg orally twice a day for 10 days
Postexposure prophylaxis: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline and ciprofloxacin are recommended as preferred agents for plague treatment or postexposure prophylaxis in a mass casualty setting.

Usual Adult Dose for Pleural Effusion

(Not approved by FDA)

Some experts recommend:
Sclerosing agent: Mix 500 mg of the powder for injection and 10 mL of lidocaine 1% in 50 mL of normal saline and inject into pleural space.

Comments:
-Clinical trials have reported use of doses ranging from 250 mg to 1 g.

Usual Adult Dose for Mycoplasma Pneumonia

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species

Some experts recommend: 100 mg orally or IV every 12 hours for 10 to 21 days

Usual Adult Dose for Pneumonia

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species

Some experts recommend: 100 mg orally or IV every 12 hours for 10 to 21 days

Usual Adult Dose for Rickettsial Infection

Approved indications: For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

Some experts recommend:
-Rocky Mountain spotted fever, relapsing fever, or typhus: 100 mg orally or IV twice a day for 7 days
-Human monocytic or granulocytic ehrlichiosis: 100 mg orally or IV twice a day for 7 to 14 days

Usual Adult Dose for Syphilis - Early

Early: 100 mg orally twice a day for 2 weeks
More than 1 year duration: 100 mg orally twice a day for 4 weeks
For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:
-Penicillin is the drug of choice.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: When penicillin is contraindicated, as alternative therapy for syphilis due to Treponema pallidum

CDC recommendations:
Primary or secondary syphilis: 100 mg orally twice a day for 14 days
Late latent syphilis or latent syphilis of unknown duration: 100 mg orally twice a day for 28 days

Usual Adult Dose for Syphilis - Latent

Early: 100 mg orally twice a day for 2 weeks
More than 1 year duration: 100 mg orally twice a day for 4 weeks
For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:
-Penicillin is the drug of choice.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: When penicillin is contraindicated, as alternative therapy for syphilis due to Treponema pallidum

CDC recommendations:
Primary or secondary syphilis: 100 mg orally twice a day for 14 days
Late latent syphilis or latent syphilis of unknown duration: 100 mg orally twice a day for 28 days

Usual Adult Dose for Tertiary Syphilis

Early: 100 mg orally twice a day for 2 weeks
More than 1 year duration: 100 mg orally twice a day for 4 weeks
For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:
-Penicillin is the drug of choice.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: When penicillin is contraindicated, as alternative therapy for syphilis due to Treponema pallidum

CDC recommendations:
Primary or secondary syphilis: 100 mg orally twice a day for 14 days
Late latent syphilis or latent syphilis of unknown duration: 100 mg orally twice a day for 28 days

Usual Adult Dose for Tularemia

Approved indication: For the treatment of tularemia due to Francisella tularensis

Some experts recommend: 100 mg orally or IV twice a day for 14 to 21 days

Working Group on Civilian Biodefense Recommendations for Treatment of Tularemia Used as a Biological Weapon:
Contained casualty setting: 100 mg IV twice a day for at least 14 days

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, not available, or inactive in vitro.

Mass casualty setting:
Treatment: 100 mg orally twice a day for 14 to 21 days
Postexposure prophylaxis: 100 mg orally twice a day for 14 days

Comments:
-Doxycycline and ciprofloxacin are recommended as preferred agents for tularemia treatment and prophylaxis in a mass casualty setting.

Usual Adult Dose for Urinary Tract Infection

Approved indication: When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Some experts recommend:
Chronic: 100 mg orally every 12 hours

Usual Pediatric Dose for Bacterial Infection

Manufacturers' general recommendations for patients above 8 years of age:IV:45 kg or less:
Initial dose: 4.4 mg/kg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 2.2 to 4.4 mg/kg IV per day, given in 1 or 2 infusions, depending on the severity of the infection

More than 45 kg:
Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg IV per day, depending on the severity of the infection; 200 mg may be given in 1 or 2 infusions

Oral:45 kg or less:
Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
Maintenance dose: 2.2 mg/kg orally per day, given once a day or in 2 divided doses
More severe infections: Up to 4.4 mg/kg orally per day

More than 45 kg:
Initial dose: 200 mg orally on the first day, given in 2 or 4 divided doses
Maintenance dose: 100 mg orally per day, given once a day or in 2 divided doses
More severe infections: 100 mg orally every 12 hours

Usual Pediatric Dose for Actinomycosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Amebiasis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Brucellosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Mycoplasma Pneumonia

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Pneumonia

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Rickettsial Infection

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Urinary Tract Infection

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Cholera

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Psittacosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Ornithosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Bartonellosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Anthrax Prophylaxis

Postexposure prophylaxis:
Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Total duration of therapy: 60 days after exposure

Comments:
-The Working Group on Civilian Biodefense has suggested doxycycline as an alternative agent if ciprofloxacin is unavailable or contraindicated, for postexposure anthrax prophylaxis in a mass casualty setting after intentional release of B anthracis.
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. See below for directions.

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

1. Put a 100 mg doxycycline tablet into a small bowl and grind into a fine powder using the back of a metal teaspoon.

2. Mix the powder with 4 teaspoons of soft food or drink until the powder dissolves. Drinks work better than foods for dissolving the powder. The taste is generally acceptable when mixed in low-fat white milk, low-fat or regular chocolate milk, chocolate pudding, or apple juice mixed with sugar. Jellies, yogurt, and water do not hide the bitter taste of doxycycline. The mixture may be stored for up to 24 hours; after that, unused portions should be thrown away. Mixtures made with milk or pudding should be refrigerated.

3. Use measuring spoons, if available, to measure the correct dose of this mixture. If the child weighs:
12.5 lbs or less: Give one-half (1/2) teaspoon (12.5 mg doxycycline) twice a day
12.5 to 25 lbs: Give one (1) teaspoon (25 mg doxycycline) twice a day
25 to 37.5 lbs: Give one and one-half (1 1/2) teaspoons (37.5 mg doxycycline) twice a day
37.5 to 50 lbs: Give two (2) teaspoons (50 mg doxycycline) twice a day
50 to 62.5 lbs: Give two and one-half (2 1/2) teaspoons (62.5 mg doxycycline) twice a day
62.5 to 75 lbs: Give three (3) teaspoons (75 mg doxycycline) twice a day
75 to 87.5 lbs: Give three and one-half (3 1/2) teaspoons (87.5 mg doxycycline) twice a day
87.5 to 100 lbs: Give four (4) teaspoons (100 mg doxycycline) twice a day

Usual Pediatric Dose for Cutaneous Bacillus anthracis

(Not approved by FDA)

Working Group on Civilian Biodefense recommendations:
Less than 45 kg: 2.2 mg/kg orally every 12 hours for 60 days
45 kg or more: 100 mg orally every 12 hours for 60 days

Comments:
-IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present.
-Ciprofloxacin or doxycycline recommended for the treatment of cutaneous anthrax after an intentional B anthracis release.
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under Usual Pediatric Dose (Anthrax Prophylaxis).

Usual Pediatric Dose for Inhalation Bacillus anthracis

Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Total duration of therapy: 60 days after exposure

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics with activity against anthrax (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin).
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under Usual Pediatric Dose (Anthrax Prophylaxis).

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

Working Group on Civilian Biodefense Recommendations for Treatment of Anthrax Used as a Biological Weapon:
Less than 8 years: 2.2 mg/kg (maximum 100 mg/dose) orally or IV every 12 hours
8 years or older and less than 45 kg: 2.2 mg/kg orally or IV every 12 hours
8 years or older and 45 kg or more: 100 mg orally or IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics.
-May switch to oral therapy when clinically appropriate
-Ciprofloxacin and doxycycline are recommended for the treatment of pulmonary anthrax after an intentional B anthracis release.

Usual Pediatric Dose for Upper Respiratory Tract Infection

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae

Usual Pediatric Dose for Bronchitis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae

Usual Pediatric Dose for Cervicitis

(Not approved by FDA)

CDC recommendations for adolescents: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline is recommended as presumptive therapy; concomitant treatment for gonococcal infection should be considered if incidence is high in patient population.
-The American Academy of Pediatrics (AAP) recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Chancroid

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-The CDC recommends azithromycin, ceftriaxone, ciprofloxacin, or erythromycin; doxycycline is not a recommended agent.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of chancroid due to H ducreyi

Usual Pediatric Dose for Chlamydia Infection

Above 8 years of age and more than 45 kg:
Uncomplicated urethral, endocervical, or rectal infection: 100 mg orally every 12 hours for 7 days
Alternative for uncomplicated urethral or endocervical infection: 200 mg orally once a day for 7 days

Approved indications: For the treatment of uncomplicated urethral, endocervical, or rectal infections due to C trachomatis

CDC recommendations:
8 years or older: 100 mg orally twice a day for 7 days

Comments:
-Single-dose azithromycin is recommended as the preferred agent if patient compliance is questionable.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Epididymitis - Sexually Transmitted

(Not approved by FDA)

CDC recommendations for children weighing more than 45 kg and adolescents: 100 mg orally twice a day for 10 days

Comments:
-The CDC recommends all patients receive ceftriaxone plus doxycycline for the initial treatment of epididymitis.
-AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

(Not approved by FDA)

CDC recommendations for children weighing more than 45 kg and adolescents: 100 mg orally twice a day for 7 days

Comments:
-The recommended regimen for uncomplicated infections of the cervix, urethra, rectum, or pharynx includes ceftriaxone plus (azithromycin [preferred] or doxycycline).
-If ceftriaxone is not available for uncomplicated infections of the cervix, urethra, or rectum, an alternative regimen includes cefixime plus (azithromycin [preferred] or doxycycline) plus test-of-cure in 1 week.
-Due to high tetracycline resistance among surveillance isolates, azithromycin is preferred as the second agent.
-The AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Granuloma Inguinale

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of granuloma inguinale due to K granulomatis

CDC recommendations for adolescents: 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

Comments:
-An aminoglycoside (e.g., gentamicin) may be added if no improvement is observed after several days.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Lyme Disease - Arthritis

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 28 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for treatment of uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease

Usual Pediatric Dose for Lyme Disease - Carditis

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 10 to 21 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of hospitalized patients; an oral regimen should be used for completion of therapy and for outpatients.

Usual Pediatric Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 10 to 21 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent

Some experts recommend: 1 to 2 mg/kg orally twice a day for 14 to 28 days
Maximum dose: 100 mg per dose

Usual Pediatric Dose for Lyme Disease - Neurologic

(Not approved by FDA)

8 years or older:IDSA recommendations:
Lyme meningitis and other manifestations of early neurologic Lyme disease: 2 to 4 mg/kg orally twice a day for 10 to 28 days
Maximum dose: 100 to 200 mg per dose

Usual Pediatric Dose for Lymphogranuloma Venereum

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications: For the treatment of lymphogranuloma venereum due to C trachomatis

CDC recommendations:
8 years or older: 100 mg orally twice a day for 21 days

Comments:
-Doxycycline is the preferred therapy.
-Patients should be clinically monitored until signs/symptoms have resolved.
-Prolonged therapy may be needed for HIV-infected patients; delay in symptom resolution may occur.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Malaria

(Not approved by FDA)

CDC recommendations:Uncomplicated malaria due to chloroquine-resistant P falciparum or P vivax:
8 years or older: 2.2 mg/kg orally twice a day for 7 days
Maximum dose: 100 mg per dose

Severe malaria in patients 8 years or older:
Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Duration of therapy: 7 days

Comments:
-Doxycycline must be used with a fast-acting schizontocide (e.g., quinine); primaquine also required if treating P vivax or P ovale.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria Prophylaxis

8 years or older: 2 to 2.2 mg/kg orally once a day
Maximum dose: 100 mg per dose

Comments:
-Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas.
-Doxycycline prophylaxis should not exceed 4 months.

Approved indication: For prophylaxis of malaria due to P falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Usual Pediatric Dose for Nongonococcal Urethritis

(Not approved by FDA)

CDC recommendations for adolescents: 100 mg orally twice a day for 7 days

Comments:
-The AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Pelvic Inflammatory Disease

Comments:
-A recommended parenteral regimen is (cefotetan or cefoxitin) plus doxycycline; an alternative parenteral regimen is ampicillin-sulbactam plus doxycycline.
-Parenteral therapy can be stopped 24 hours after clinical improvement but oral doxycycline should continue to complete 14 days of therapy; when tuboovarian abscess is present, metronidazole or clindamycin can be used with doxycycline for continued therapy (provides more effective anaerobic coverage than doxycycline alone).
-Recommended regimens for outpatient, oral therapy include (ceftriaxone or cefoxitin/probenecid or other parenteral third-generation cephalosporin) plus oral doxycycline with or without metronidazole.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Plague

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of plague due to Y pestis

Working Group on Civilian Biodefense Recommendations for Treatment of Plague Used as a Biological Weapon:8 years or older:Contained casualty setting:
Less than 45 kg: 2.2 mg/kg IV twice a day (maximum 200 mg/day)
45 kg or more: 100 mg IV twice a day
Duration of therapy: 10 days (or until 2 days after fever subsides)

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Usual Pediatric Dose for Trachoma

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-The infectious agent is not always eliminated, as evaluated by immunofluorescence.

Approved indication: For the treatment of trachoma due to C trachomatis

Usual Pediatric Dose for Tularemia

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of tularemia due to F tularensis

Working Group on Civilian Biodefense Recommendations for Treatment of Tularemia Used as a Biological Weapon:Contained casualty setting:
Less than 45 kg: 2.2 mg/kg IV twice a day (maximum 200 mg/day)
45 kg or more: 100 mg IV twice a day
Duration of therapy: At least 14 days

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Duration of therapy:
Treatment: 14 to 21 days
Postexposure prophylaxis: 14 days

Comments:
-Doxycycline and ciprofloxacin are recommended for tularemia treatment and prophylaxis in a mass casualty setting.

Renal Dose Adjustments

Most formulations: No adjustment recommended.
Oracea(R): May need to adjust dose; however, no specific guidelines have been suggested.

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Dialysis does not alter serum half-life of doxycycline.

Other Comments

Administration advice:
-Avoid rapid administration of IV doxycycline; infusion duration may vary with dose, but is generally 1 to 4 hours; minimum infusion time recommended for 100 mg of a 0.5 mg/mL solution is 1 hour.
-Do not inject IV solutions IM or subcutaneously; caution recommended to avoid extravasation.
-IV doxycycline only recommended short-term when oral therapy is not indicated; the switch from IV to oral therapy should be made as soon as it is clinically feasible.
-Due to pain with IV infusion, doxycycline should be used orally when possible.
-Therapy should continue for at least 24 to 48 hours after symptoms/fever subside.
-Oral doxycycline should be taken with plenty of fluid in an upright position to reduce the risk of esophageal irritation and ulceration.
-Most oral doxycycline products should be taken with food or milk if gastric irritation occurs; absorption not significantly affected by food or milk.
-Oracea(R) and doxycycline hyclate 20 mg should be taken on an empty stomach, 1 hour before or 2 hours after a meal.

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.